The objectives of the project, Surveillance for Adverse Drug Events in Ambulatory Pediatrics are to reliably measure the incidence of adverse drug events (ADEs), or harm to patients from drugs, suffered by children with chronic diseases in the ambulatory environment, and during transitions in care in and out of the ambulatory environment. Measuring the incidence of harm from drugs is an important step toward reducing this harm. We will use a computerized system to detect and report ADEs that occur in the outpatient setting, in the emergency department, and during the transitions of hospital admission and discharge. The computer system will use an expert systems architecture to automatically scan laboratory, pharmacy, demographic, documentation and diagnostic code data from our target populations - children with sickle cell disease, cystic fibrosis, and cancer -- for "signals," or data combinations that suggest the occurrence of an ADE. These signals will be compiled into a regular report for investigation in detail by clinicians trained in ADE evaluation to determine whether each signal represents an ADE. If an ADE is determined to have occurred, the investigator will evaluate its causality and severity, and initiate a procedure for follow-up tracking and data gathering. The event will be documented to a secure database and scrubbed of identifiers for aggregate analysis and reporting. In addition, the system will permit immediate intervention and mitigation of ADEs in some cases. The system will be evaluated for efficiency (positive predictive value and time/resource efficiency), effectiveness in ADE detection compared with targeted explicit chart review; and we will examine the impact of access to ADE metrics by practitioners. The data from the system will be used to improve medication use safety in clinic, emergency, and inpatient environments. Ultimately, the system will permit evaluation of the effectiveness of any medication safety improvement strategy employed in the care settings where these patients are seen. Dissemination of the project and its findings will be via a collaborative with the Child Health Corporation of America, and sharing through the Cystic Fibrosis Foundation. [unreadable] [unreadable] [unreadable] [unreadable]